If the patient meets criteria for a diagnosis of major depression, we would intervene with the combinations of medication and psychotherapy. The most important thing to consider in selecting medications or interventions for new mothers is to really look at the big picture.
It's extremely important for new mothers to sleep. It’s extremely important for new mothers to have a good feeling about their interactions with the baby, extremely important for women, for anybody with depression to have relief of their symptoms. Fifteen percent of people with untreated depression die of suicide, and so it’s not a benign condition. It’s a very serious condition, and persistent depression in a new mother has a very dramatic effect on a developing infant.
So even more important than any pharmacologic effect that medications might have in breast milk and the fetus is the effect of a depressed mother on a new baby, and that’s been found to be true in article after article over the last really 40 years in the medical literature. So we look at a combination of treatments, and we think about a bio-psychosocial perspective.
So medications, what are the most appropriate medications? What are the safest medications? Does the patient need to sleep? Is a patient too lethargic? What side effect profile are we looking for?
Psychological interventions: is this an individual who needs to be seen for supportive contact? Is this a person who needs to be seen for more intensive psychotherapy? And is this an individual who is having a lot of tension at home and should be seen with her partner to sort of problem-solve but also elicit support, and the social or environmental factors.
What can we do to create an environment at home that’s conducive to the mother’s healing and recovery and also provides her with positive experiences in parenting the baby? If she is breast-feeding and it’s going terribly and the baby is not gaining weight, would it be useful for her to meet with a lactation consultant?
Would it be useful for her to share feedings with her partner or with a caregiver so that she is not always facing that anxiety about the feedings every two hours?
Are there other ways that we can manage her home environment to provide her with support, to make sure that she can sleep, and to surround her with people who are nurturing and supportive to give her, again, a sense of confidence and competence in the way that she is interacting with her baby?
Dr. Nehama Dresner Associate Professor of Clinical Psychiatry and Obstetrics-Gynecology, Northwestern University
Dr. Nehama Dresner is a licensed, Board-certified psychiatrist (in general psychiatry and psychosomatic medicine) with specialized training and nearly 20 years experience in Women's Mental Health and Medical Psychiatry. more about this expert »